Mark Wolfson

Project Northland: outcomes of a communitywide alcohol use prevention program during early adolescence.

OBJECTIVES Project Northland is an efficacy trial with the goal of preventing or reducing alcohol use among young adolescents by using a multilevel, communitywide approach. METHODS Conducted in 24 school districts and adjacent communities in northeastern Minnesota since 1991, the intervention targets the class of 1998 (sixth-grade students in 1991) and has been implemented for 3 school years (1991 to 1994). The intervention consists of social-behavioral curricula in schools, peer leadership, parental involvement/education, and communitywide task force activities. Annual surveys of the class of 1998 measure alcohol use, tobacco use, and psychosocial factors. RESULTS At the end of 3 years, students in the intervention school districts report less onset and prevalence of alcohol use than students in the reference districts. The differences were particularly notable among those who were nonusers at baseline. CONCLUSIONS The results of Project Northland suggest that multilevel, targeted prevention programs for young adolescents are effective in reducing alcohol use.

Caffeinated Cocktails: Energy Drink Consumption, High‐risk Drinking, and Alcohol‐related Consequences among College Students

OBJECTIVES The consumption of alcohol mixed with energy drinks (AmED) is popular on college campuses in the United States. Limited research suggests that energy drink consumption lessens subjective intoxication in persons who also have consumed alcohol. This study examines the relationship between energy drink use, high-risk drinking behavior, and alcohol-related consequences. METHODS In Fall 2006, a Web-based survey was conducted in a stratified random sample of 4,271 college students from 10 universities in North Carolina. RESULTS A total of 697 students (24% of past 30-day drinkers) reported consuming AmED in the past 30 days. Students who were male, white, intramural athletes, fraternity or sorority members or pledges, and younger were significantly more likely to consume AmED. In multivariable analyses, consumption of AmED was associated with increased heavy episodic drinking (6.4 days vs. 3.4 days on average; p < 0.001) and twice as many episodes of weekly drunkenness (1.4 days/week vs. 0.73 days/week; p < 0.001). Students who reported consuming AmED had significantly higher prevalence of alcohol-related consequences, including being taken advantage of sexually, taking advantage of another sexually, riding with an intoxicated driver, being physically hurt or injured, and requiring medical treatment (p < 0.05). The effect of consuming AmED on driving while intoxicated depended on a students reported typical alcohol consumption (interaction p = 0.027). CONCLUSIONS Almost one-quarter of college student current drinkers reported mixing alcohol with energy drinks. These students are at increased risk for alcohol-related consequences, even after adjusting for the amount of alcohol consumed. Further research is necessary to understand this association and to develop targeted interventions to reduce risk.

The effects of community policies to reduce youth access to tobacco.

OBJECTIVES This study tested the hypothesis that adoption and implementation of local policies regarding youth access to tobacco can affect adolescent smoking. METHODS A randomized community trial was conducted in 14 Minnesota communities. Seven intervention communities participated in a 32-month community-organizing effort to mobilize citizens and activate the community. The goal was to change ordinances, merchant policies and practices, and enforcement practices to reduce youth access to tobacco. Outcome measures were derived from surveys of students before and after the intervention and from tobacco purchase attempts in all retail outlets in the communities. Data analyses used mixed-model regression to account for the clustering within communities and to adjust for covariates. RESULTS Each intervention community passed a comprehensive youth access ordinance. Intervention communities showed less pronounced increases in adolescent daily smoking relative to control communities. Tobacco purchase success declined somewhat more in intervention than control communities during the study period, but this difference was not statistically significant. CONCLUSIONS This study provides compelling evidence that policies designed to reduce youth access to tobacco can have a significant effect on adolescent smoking rates.

Resource mobilization by local social movement organizations: Agency, strategy, and organization in the movement against drinking and driving

Mobilization of resources is a central concern among analysts of social movements. However little research has focused on factors that influence the types and amounts of resources collective actors are able to mobilize. In this study, data from local social movement organizations opposing drinking and driving are used to assess the roles of agency (i.e., amount of effort), strategy, organizational structure, and nature of national affiliation in the mobilization of resources. Measures of agency consistently predict mobilization of volunteer labor revenue, and membership. Strategy seems less important. An emphasis on victim services was positively related only to mobilization of members. Organizational structure, particularly the number of task committees, was consistently related to mobilization of volunteer label; revenue, and membership. Affiliation with a highly visible and highly legitimated national organization, Mothers Against Drunk Driving (MADD), appears to have an energizing effect on local leaders while it dampens the effects of agency, strategy, and organizational structure. These results are interpreted within the distinctive political and cultural context of the movement against drinking and driving.

Communities mobilizing for change on alcohol: Lessons and results from a 15-community randomized trial

Communities Mobilizing for Change on Alcohol (CMCA) is a 15-community randomized trial designed to develop, implement, and evaluate a 2½ year community organizing intervention to change policies and practices of major community institutions. Pre- and post-data were collected via: surveys of high school students, surveys of youth age 18–20, surveys of alcohol retailers, alcohol purchase attempts, content analyses of media coverage, arrest and car crash indicators, surveys of strategy team members, and process records. Organizers and local strategy teams changed policies and practices of community institutions such as law enforcement agencies, alcohol merchants, and sponsors of community events, leading to significant changes in alcohol-related behaviors among 18- to 20-year-olds, and significant reductions in the propensity of alcohol establishments to serve alcohol to youth.

Enforcement of the Legal Minimum Drinking Age in the United States

We studied patterns and levels of enforcement of the legal drinking age in the United States. Major findings include: (1) rates of enforcement of the legal drinking age are very low; (2) actions against outlets or adults providing alcohol to youth are particularly rare; (3) two of every thousand occasions of illegal drinking by youth under 21 are estimated to result in an arrest; (4) five of every 100,000 youth drinking occasions are estimated to result in an Alcohol Beverage Control agency action against an alcohol outlet; (5) penalties appear too lenient to deter providers of alcohol; and (6) levels of enforcement of the drinking age vary significantly across states.Recommendations for public policy and enforcement actions include: (1) increased enforcement effort be directed at those who provide alcohol to underage youth; (2) significant increases in the numbers of Alcohol Beverage Control enforcement personnel are needed; (3) one or more officers in each local enforcement agency should be designated as the alcohol control officer; (4) regular sting operations in retail alcohol outlets are needed; (5) all police-attended alcohol-involved incidents should include a record of the source of the alcohol; and (6) effective long-term efforts will require attention to the broader environment that encourages youth drinking.

Adolescent smokers' provision of tobacco to other adolescents:

OBJECTIVES This study examined adolescent smokers provision of tobacco to other adolescents. METHODS Data from a survey of 8th-, 9th-, and 10th-grade students in Minnesota were analyzed by using mixed-model logistic regression. RESULTS More than two thirds (68.8%) of adolescent smokers had provided tobacco to another adolescent in the previous 30 days. Mothers smoking, number of friends who smoke, owning tobacco merchandise, number of cigarettes smoked in the past week, source of last cigarette (commercial), and recent attempt to buy cigarettes were associated with providing. CONCLUSIONS The social availability of tobacco to youth needs further examination.

PERCEIVED AND MEASURED AVAILABILITY OF TOBACCO TO YOUTHS IN 14 MINNESOTA COMMUNITIES : THE TPOP STUDY

INTRODUCTION Availability of tobacco to young people is believed to be an important factor in the onset of tobacco use. We still do not have a complete picture of how tobacco is obtained by youths or how access can be curtailed. DESIGN This article describes tobacco availability to youths in 14 communities that are part of a randomized trial, known as TPOP (Tobacco Policy Options for Prevention). The data reported here were obtained from student surveys and tobacco-purchase attempts by underage confederates. RESULTS Students who have smoked at least once were likely to cite social sources for cigarettes. However, more than half of weekly smokers and almost one third of tenth-grade ever smokers reported purchasing cigarettes in the last 30 days. Tobacco-purchase attempts by confederate buyers at all outlets resulted in an overall success rate of 40.8%, lower than previously reported for urban communities. Fifty-five percent of the over-the-counter outlets had no self-service displays of tobacco at baseline. Store factors that predicted purchase success include tobacco location; purchase success was lower when all tobacco was locked or behind a service counter. The percentage of smokers who reported purchasing their own tobacco soon after starting to smoke was highest in towns where purchase success by teenage study confederates was highest. CONCLUSIONS These results suggest that sources of cigarettes shift from social to commercial with age and that sources of cigarettes for rural youths may be different than for urban youths.

Everyone Says It's OK: Adolescents’ Perceptions of Peer, Parent, and Community Alcohol Norms, Alcohol Consumption, and Alcohol-Related Consequences

An adolescents perception of norms is related to her or his engagement in alcohol-related behaviors. Norms have different sources, such as parents, peers, and community. We explored how norms from different sources were simultaneously related to different alcohol-related behaviors (current drinking, drunkenness, heavy episodic drinking, driving under the influence or riding with a impaired driver, and alcohol-related nonviolent consequences) using data collected in 2004 from 6,958 adolescents from 68 communities in five states. Results revealed that parent, friend, and community norms were related to adolescents’ alcohol-related behavior, but the strength of these impacts varied across behaviors. The pattern of results varied when the analysis relied on all adolescents or just those who had consumed alcohol in the last year.

Latino men who have sex with men and HIV in the rural south-eastern USA: findings from ethnographic in-depth interviews.

A community-based participatory research partnership explored HIV risk and potentially effective intervention characteristics to reduce exposure and transmission among immigrant Latino men who have sex with men living in the rural south-eastern USA. Twenty-one participants enrolled and completed a total of 62 ethnographic in-depth interviews. Mean age was 31 (range 18–48) years and English-language proficiency was limited; 18 participants were from Mexico. Four participants reported having sex with men and women during the past three months; two participants self-identified as male-to-female transgender. Qualitative themes that emerged included a lack of accurate information about HIV and prevention; the influence of social-political contexts to sexual risk; and barriers to healthcare services. We also identified eight characteristics of potentially effective interventions for HIV prevention. Our findings suggest that socio-political contexts must be additional targets of change to reduce and eliminate HIV health disparities experienced by immigrant Latino men who have sex with men.